When I saw this patient who had a cellulitis, I thought "Aren't cellulites for fat women only? You must have really messed up to get some cellulites." Well this guy was not fat. He was a diabetic but he had a normal heart rate and blood pressure. I thought cellulitis was a condition of having cellulites. I was wrong.
Cellulitis is an inflammation of the connective tissue underlying the skin, that can be caused by a bacterial infection. Cellulitis can be caused by normal skin flora or by exogenous bacteria, and often occurs where the skin has previously been broken: cracks in the skin, cuts, burns, insect bites, surgical wounds, or sites of intravenous catheter insertion. The mainstay of therapy remains treatment with appropriate antibiotics. It is unrelated to "cellulite," a cosmetic condition featuring dimpling of the skin.
Symptoms
Cellulitis is characterized by redness, swelling, warmth, and pain or tenderness. Cellulitis frequently occurs on exposed areas of the body such as the arms, legs, and face. Other symptoms can include fever or chills and headaches. In advanced cases of cellulitis, red streaks (sometimes described as ‘fingers’) may be seen traveling up the affected area. The swelling can spread rapidly.
Causes
Cellulitis is caused by a number of types of bacteria entering by way of a break in the skin. This break need not be visible. Group A streptococcus and staphylococcus are the most common of these bacteria, which are part of the normal flora of the skin but cause no actual infection until the skin is broken. Predisposing conditions for cellulitis include insect bite, animal bite, pruritic skin rash, recent surgery, athlete’s foot, swollen skin, dry skin, eczema, and burns.
Treatment
If the case of cellulitis is minor, oral antibiotics may be all that are necessary. These are often intended to be taken for about ten days, and the patient usually sees his or her doctor after a day or two of taking the medication to ensure that it is working correctly. In addition, the doctor may instruct the patient to elevate the affected area. Antipyretics or anti-inflammatory drugs may also be used.
If the oral antibiotics do not work or if the patient has a high fever when he or she comes to see the doctor, intravenous (IV) antibiotics will most likely be necessary. IV antibiotics can be administered at a clinic, the hospital, or the patient’s home. The specific antibiotic prescribed will depend on the physician's assessment as to the most likely causative bacteria: usually Gram-positive organisms will be covered with an antistaphylococcal antibiotic, like flucloxacillin, and in specific situations Gram-negative organisms, anaerobic organisms, or specific species will be covered. If the infection forms an abscess, it may require surgical incision and drainage of the collected pus.
In the most serious cases, the cellulitis may spread to the bloodstream (causing septicemia) and other tissue, especially bone (causing osteomyelitis). In these cases, or where antibiotic therapy is unsuccessful, surgical debridement may be necessary.
In rare cases, secondary infections such as necrotizing fasciitis, where rapid necrotization of skin, fat, and connective tissue may necessitate surgical debridement of affected areas.The patient said that this happened after he fell and his knee was wounded. I guess that's what happens when you refuse to take showers for days. And yes, he did show me his infectious sites.
